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General NPI Number Information
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NPI Number | 1275210957
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Entity Type | Individual
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Provider Name | LOLA BENAVIDEZ
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Gender | Female
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 477 MADISON AVE STE 6812
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City | NEW YORK
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State | NY
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Zip | 10022-5802
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Country | US
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Telephone | 332-282-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 543 E 5TH ST APT 9
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City | NEW YORK
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State | NY
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Zip | 10009-6731
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Country | US
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Telephone | 310-488-3956
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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